Association Between Low Zinc Levels and Severity of Acute Respiratory Distress Syndrome by New Coronavirus SARS-CoV-2

Background: We verify the prevalence of low zinc levels among critically ill patients infected by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in the intensive care unit (ICU) who required invasive mechanical ventilation, as well as its association with severity of acute respiratory distress syndrome (ARDS).

Methods: This is an observational study composed of patients admitted to the ICU. Demographics, anthropometric data for calculating body mass index (BMI), and laboratory data were obtained at admission: blood count, ferritin, arterial blood gas, serum zinc levels, and C-reactive protein. Also, arterial oxygen tension (PaO ) divided by fractional inspired oxygen (FiO ) was calculated by the first arterial blood gas after intubation. A diagnosis of severe ARDS was determined if the PaO /FiO ratio was ≤100 mm Hg. Low zinc levels were established if zinc levels were <70 μg/dL.

Results: A total of 269 patients met inclusion criteria; 51.3% were men; median age was 74 (66-81) years; 91.1% (245 of 269) were elderly. The median BMI was 30.1 (24.7-32.1) kg/m , with 59.9% (161 of 269) of patients having overweight and obesity. The prevalence of low zinc levels was 79.6% (214 of 269) and severe ARDS was 56.5% (152 of 269). There was an association of low zinc levels and severe ARDS (odds ratio [OR], 14.4; 95% CI, 6.2-33.5; P < .001), even after adjusting for baseline variables (OR, 15.4; 95% CI, 6.5-36.3; P < .001).

Conclusion: Critically ill patients infected by SARS-CoV-2 with severe ARDS have a high prevalence of low serum zinc levels.